Provider Demographics
NPI:1457952871
Name:SPRINGER, SHELBY KATHRYN (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:KATHRYN
Last Name:SPRINGER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 S 48TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5303
Mailing Address - Country:US
Mailing Address - Phone:325-672-7055
Mailing Address - Fax:
Practice Address - Street 1:2350 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3238
Practice Address - Country:US
Practice Address - Phone:707-798-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59008363A00000X
AZ8214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ083435Medicaid
AZ8214OtherSTATE LICENSE
CAPA59008OtherSTATE LICENSE